后路伤椎置钉短节段椎弓根钉内固定治疗胸腰椎爆裂骨折

Posterior short-segmental pedicle screw fixation in treatment of thoracolumbar burst fracture

目的观察后路伤椎置钉短节段椎弓根钉固定治疗胸腰椎爆裂骨折的疗效。方法回顾26例分别应用伤椎置钉﹙A组,n=12﹚和非伤椎置钉﹙B组,n=14﹚短节段椎弓根钉固定治疗胸腰椎爆裂骨折临床和影像学资料,比较2组手术出血量、手术时间、神经功能﹙Frankel分级﹚、后凸角﹙手术前、术后2周、随访末期﹚及骨折椎楔变指数,并记录手术并发症。结果 A、B 2组在性别、年龄、Frankel分级、后凸角及骨折节段分布等无统计学差异﹙>0.05﹚;A组在后凸角矫正优于B组,但2组间无统计学意义﹙>0.05﹚;A组在后凸角矫正丢失优于B组,2组间差异有统计学意义﹙<0.05﹚;A组手术时间明显长于B组﹙<0.05﹚,出血量也多于B组﹙<0.05﹚。结论后路伤椎置钉短节段椎弓根钉固定是治疗胸腰段爆裂骨折的有效方法,可有效预防后凸矫正丢失,虽手术时间及出血量增多,但并未增加手术并发症。

Objective To evaluate the efficacy and clinical outcome of the treatment of thoracolurnhar burst fractures by using short-segmental pedicle screw at the fracture level. Methods 26 patients with thoracolumbar burst fractures treated by posterior fixation were divided into short-segmental fixation combine fracture vertebrae screw groul（ Group A, n=12 ） and short-segmental posterior fixation group （ Group B, n=14 ）. Clinical and radiographic results were reviewed retrospec- tively. Blood loss、 operative time, kyphosis angle, wedge index（ before the operation, within 2 weeks after operation and the last follow-up ）neurologic status（ Frankel grade ）and complications of surgery were observed and compared between the 2 groups. Results There were no significant difference between the 2 group in gender、 age 、 Frankel grade 、 preoperative kyphosis angle and, the location of fracture segment statistically. The kyphosis angle correction in group A was no better than that of group B（ P〉0.05 ）, but the correction loss in the group A was less than that of group BC P 〈0.05 ） the operative time was longer, and the blood lost was more, than that of group B（ P 〈0.05 ）. 1 case of postoperative screw breakage hap- pened in group B, while there are no implants fail in group A. Conclusion This study showed that segmental posterior fix- ation is an effective and safe treatment for thoracolumbar burst fractures, which can effectively prevent the loss of postoperative kyphosis correction, though it increases the operative time and blood loss.